Individual
MIKAELA MANTELE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
101 FAIRVIEW PARK DR, DUBLIN, GA 31021-2501
(478) 272-7494
Mailing address
305 RAINBOW RD, ELLABELL, GA 31308-8587
(303) 717-0551
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
Primary
PTA004126
GA
Other
Enumeration date
10/25/2018
Last updated
10/25/2018
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